Basic Information
| Provider Information | |||||||||
| NPI: | 1710036702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIBERT | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 8667954020 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 MONUMENT CIRCLE | ||||||||
| Address2: | STE 125 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176311200 | ||||||||
| FaxNumber: | 3176311600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046-009765 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 346002316 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 1726 | KS | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 12871 | CA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 18003691A | IN | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 18003691B | IN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.